Lupus and enlarged liver

I have been tentatively diagnosed with Lupus.
Started with chest pain (upper left quadrant) and elbow pain (only when leaning on it)
Primary physician ran limited bloodwork and ANA was high positive > 1:1280 with speckled pattern.
Referred to rheumatologist who confirmed definitely autoimmune just can't tell right off the bat which one. (tests pending).
Diagnosed me with Raynauld's syndrome due to blueing of hand and feet.
Also found that my liver is enlarged. My liver enzymes are normal (AST 12 range 10-30 and ALT 10 range 6/40)
I am nerve racked to find out my liver is enlarged. How worried should I be? Can't you have normal liver enzyme levels even with a liver that is actually not functioning well? I have 3 young children so this whole chain of events has me worried silly even though I know things could be worse.

Lupus can cause an enlarged liver. (hepatomegaly) It is found in 10%of patients with SLE. The liver is rarely tender unless the enlargement is so great that the covering of the organ is stretched. The most common causes of large livers in lupus include autoimmune hepatitis, ascites, congestive heart failure or a complication of a large spleen, whose materials drain into the liver.

Hepatic vasculitis is extremely rare and is noted in just one lupus patient per thousand.

Have you had pain in your upper right side of your abdomen? Is your skin or whites of your eyes yellow?

There is a condition called autoimmune hepatitis. It is defined by (1) liver disease consistent with chronic active hepatitis; (2) absence of evidence for active hepatisis virus A, B, or C infectio; and (3) a positive ANA or other autoantibodies associated with the syndrome.

Even using these criteria, only 10% of patients with antoimmune hepatitis fulfilled the American College of Rhematolgy criteria for lupus. Many of the physical findings we associate with SLE (rashes and other organ involvement) are usually absent. About 30-60% of those with autoimmune hepatitis also have antibodies to smooth muscle or mitochondria (AMA or SMA).

Autoimmune hepatis usually responds to steroids, alpha-interferon and azathioprine.

Just make sure you are NOT drinking alchol or some medication that can damage your liver. A friend of mine had some funky thing going on in her liver. It ended up being the seraquil (anti depresant). She's good to go now.

Thanks for posting. The information was great.
I have never had pain in upper abdomen. I have never had yellowing of skin, etc. Liver enzymes are normal for whatever that is worth. Just doctor palpated liver as enlarged on exam. I am just overwhelmed as I went in originally for elbow pain that only hurts if I lean on a desk with tip of elbow and chest pain that went away in 1-2 days. I really just wanted to make sure chest pain wasn't heart related since you hear all these things about heart disease in women being missed. Now I have Lupus (tentative), Raynauds and liver enlargement. I guess I am fortunate in that I feel fairly good. I have trouble sleeping from anxiety and I am a little overun taking care of 3 young kids by myself (husband doesn't help with them). I am just scared at this point and until recheck with doctor in 2 weeks don't really know what prognosis will be. When it was just Raynauds and Lupus I felt somewhat okay. Now that there seems to be organ involvement - ie the liver I am back to freaking out again. It is like a roller coaster ride and you just want to get off.

Hi,
I also have an enlarged liver. I have had elevated liver enzymes a few times, but my doc said its nothing to worry about. I also have some lesions on my liver & they didn't seem worried about that either. So try not to stress, I know it's hard. But that doesn't help at all ;-)

Thanks for the post. I have seen a lot of information about lupus and its effects on the kidneys but not much on the liver. It makes sense that anywhere in the body can be affected. I was just wondering if other people had liver involvement. It am just trying to understand why the liver is enlarged yet normal enzymes and my doctor not really saying anything about it.

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